Medicaid’s raise for primary care docs to disappear

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Twenty-dollar bill in a pill bottleBy Michael Ollove
Stateline

A temporary bump in Medicaid fees paid to primary care doctors, an Affordable Care Act provision intended to get more physicians to accept Medicaid patients, will expire at the end of this month.

Congress did not extend the higher rates, so unless states take action themselves or the new Congress revisits the issue, primary care doctors in Medicaid will see their fees fall by an average of nearly 43 percent starting in January, according to a new report from the Urban Institute.

Unless action is taken primary care doctors in Medicaid will see their fees fall by an average of nearly 43 percent starting in January.

Whether the expiration of the fee increase will make a difference in physician participation in Medicaid is unknown. That is because there hasn’t been enough time to analyze whether the hike actually convinced primary care doctors to take Medicaid patients.

“It’s expiring before it’s been evaluated,” said Sandra Decker, a researcher at the National Center for Health Statistics, an arm of the Centers for Disease Control and Prevention.

Decker, who has published widely on the Medicaid physician workforce, said she will analyze the impact of the fee increase, but doubts her results will be complete before the end of next year.

Still, she noted, past evidence indicates that Medicaid pay increases spur participation by physicians. She predicted that the lower fees will make it harder for Medicaid patients to find doctors willing to see them or that they will have to endure long waits to see doctors who accept Medicaid patients.

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Too little, too late for many New Yorkers seeking hospice

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By Fred Mogul, WNYC

Sandra Lopez and her Chihuahua, Coco, were inseparable. He followed her everywhere, and kept Lopez’s mood up when she was in pain – which was often.

On Oct. 15, Lopez, died at age 49 of pancreatic and vaginal cancer that had slowly spread throughout her body over two years. She left behind a 15-year-old daughter and little Coco. But with hospice care, she spent her last weeks where she wanted to be — at home, with her pain under control.

Sandra was in and out of the hospital in 2014, but for the months she was home, a hospice nurse from Metropolitan Jewish Health System visited once a week to help manage the pain, backed up by a 24-hour, nurse-staffed phone line that Lopez called often.

“Some days the pain is so excruciating,” she told me in August from the couch in her Brooklyn apartment, “that the pain overrides the medication.”

But despite evidence that hospices can greatly relieve discomfort, extend life and save money, and despite a generous hospice benefit available through both Medicare and Medicaid, relatively few people in New York take advantage of it, compared to elsewhere in the country.

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Public easily swayed by arguments for and against employer mandate, poll

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Yes-No-MaybeBy Julie Rovner
KHN

Just days before the requirement for most large employers to provide health insurance takes effect, a new poll finds the public easily swayed over arguments for and against the policy.

Six in 10 respondents to the monthly tracking poll from the Kaiser Family Foundation (Kaiser Health News is an editorially independent program of the foundation) said they generally favor the requirement that firms with more than 100 workers pay a fine if they do not offer workers coverage.

But minimal follow-up information can have a major effect on their viewpoint, the poll found.

kaiser poll

For example, when people who support the “employer mandate” were told that employers might respond to the requirement by moving workers from full-time to part time, support dropped from 60 percent to 27 percent.

And when people who disapprove of the policy were told that most large employers will not be affected because they already provide insurance, support surged to 76 percent.

Opinion also remains malleable about the requirement for most people to have health insurance – the so-called “individual mandate.”

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Health news headlines – December 18th

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Global health – December 18th

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Globe floating in air

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DON’T PANIC: The world might not be as bad as you might believe!

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Don’t Panic – is a one-hour long documentary produced by Wingspan Productions and broadcasted on BBC on the 7th of November 2013.

The visualizations are based on original graphics and stories by Gapminder and the underlaying data-sources are listed here. Hans presents some results from our UK Ignorance Survey described here.

 

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Vera Whole Health to run employee clinic for City of Kirkland

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Screen Shot 2014-12-17 at 12.35.36 PMVera Whole Health has signed an agreement with the City of Kirkland to offer primary, preventive and acute care to City of Kirkland employees at a new worksite clinic.

The Seattle-based company offers on-site and near-site health clinics for organizations. Employers pay monthly fee for their employees to receive unlimited primary care, acute care and health coaching.

The company staffs the clinics with physicians, nurse practitioners, medical assistants and health coaches. The goal of the employer-funded clinics is to help employees develop and maintain healthy lifestyles, reversing the trend of rising overall health care costs, the company says.

In the Puget Sound region, the company maintains clinics for Seattle Children’s Hospital, the Bill & Melinda Gates Foundation, Trident Seafoods in Ballard and a Seattle-based investment company.

The City of Kirkland clinic is expected to open in the spring of 2015 and will be located in the Totem Lake area.

 

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As controlled substance use rises in Medicare, prolific prescribers face more scrutiny

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pills-spill-out-of-bottle

By Charles Ornstein and Ryann Grochowski Jones
ProPublica

This story was co-published with USA Today and NPR’s Shots blog.

Despite a national crackdown on prescription drug abuse, doctors churned out an ever-larger number of prescriptions for the most-potent controlled substances to Medicare patients, new data shows.

In addition, ProPublica found, the most prolific prescribers of such drugs as oxycodone, fentanyl, morphine and Ritalin often have worrisome records.

In 2012, the most recent year for which data is available, Medicare covered nearly 27 million prescriptions for powerful narcotic painkillers and stimulants with the highest potential for abuse and dependence.

That’s up 9 percent over 2011, compared to a 5 percent increase in Medicare prescriptions overall.

Even taking into account an increase in the number of Medicare enrollees, the prescribing rate rose slightly for these drugs, which are classified as Schedule 2 controlled substances by the Drug Enforcement Administration.

Twelve of Medicare’s top 20 prescribers of Schedule 2 drugs in 2012 have faced disciplinary actions by their state medical boards or criminal charges related to their medical practices, and another had documents seized from his office by federal agents.

The No. 1 prescriber 2014 Dr. Shelinder Aggarwal of Huntsville, Ala., with more than 14,000 Schedule 2 prescriptions in 2012 2014 had his controlled substances certificate suspended by the state medical board in March 2013. He surrendered his medical license four months later. (Aggarwal could not be reached for comment.)

Prescribing high volumes of Schedule 2 drugs can indicate a doctor is running a pill mill, said Dr. Andrew Kolodny, chief medical officer of Phoenix House, a New York-based drug treatment provider. Government regulators should do more to monitor prescribing patterns and intervene proactively if they appear aberrant, he said.

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Avoid powdered pure caffeine, FDA warns.

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From the US Food and Drug Administration

The FDA is warning about powdered pure caffeine being marketed directly to consumers, and recommends avoiding these products.

In particular, FDA is concerned about powdered pure caffeine sold in bulk bags over the internet.

The FDA is aware of at least one death of a teenager who used these products.

1000px-Main_symptoms_of_Caffeine_overdose

These products are essentially 100 percent caffeine. A single teaspoon of pure caffeine is roughly equivalent to the amount in 25 cups of coffee.

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Health news headlines – December 17th

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Global health news – December 17th

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State wins $65 million to improve health care

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Washington MapFrom the Washington State Health Care Authority

Washington won a $65 million grant to bolster health care innovation in the state, Gov. Jay Inslee announced today.

Awarded by the Center for Medicare and Medicaid Innovation (CMMI), the federal grant supports the Healthier Washington project developed through a collaboration of state leaders, the Legislature, health care systems and community members.

Healthier Washington’s purpose is to achieve the “Triple Aim” for the state’s population: better health, better care, and lower costs.

Goals of the plan:

  1. Build healthier communities and people through prevention and early attention to disease
  2. Integrate care and social supports for individuals who have both physical and behavioral health needs
  3. Reward quality heath care over quantity, with state government leading by example as Washington’s largest purchaser of health care

Washington is one of 11 states to get the four-year testing grant, which begins in February 2015. The Washington State Health Care Authority (HCA) will serve as lead agency for the grant.

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10 reasons why healthcare isn’t a free market – Modern Healthcare

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Photo by Sanja Gjenero

Photo by Sanja Gjenero

No. 1: Nobody in the middle of a heart attack shouts, “Let’s go shopping!” Some other reasons, writes Merrill Goozner in Modern Healthcare are: Comparison shopping is complex, doctors belong to professional guilds, and most care is delivered locally so foreign competition can’t drive down prices.

10 reasons why healthcare isn’t a free market – Modern Healthcare.

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Teen prescription opioid abuse, cigarette, and alcohol use down, but e-cigarette use up

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Two white tabletsFrom the US Department of Health and Human Services

Use of cigarettes, alcohol, and abuse of prescription pain relievers among teens has declined since 2013 while marijuana use rates were stable, according to the 2014 Monitoring the Future (MTF) survey, released today by the National Institute on Drug Abuse (NIDA). However, use of e-cigarettes, measured in the report for the first time, is high.

These 2014 results are part of an overall two-decade trend among the nation’s youth. The MTF survey measures drug use and attitudes among eighth, 10th, and 12th graders, is funded by NIDA, and is conducted by researchers at the University of Michigan at Ann Arbor. NIDA is part of the National Institutes of Health.

“With the rates of many drugs decreasing, and the rates of marijuana use appearing to level off, it is possible that prevention efforts are having an effect,” said NIDA Director Nora D. Volkow, M.D.

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